The prevalence of allergic rhinitis in children and adolescents is constantly increasing. However, few studies exist on the relationship between smoking and allergic rhinitis. In addition to conventional cigarettes, electronic and heated cigarettes have recently been introduced, which have several harmful effects. It is hypothesized that smoking and rhinitis are correlated; however, this relationship is complex. Previous studies reported that exposure to smoking during pregnancy is associated with allergic rhinitis development. Unlike the varied results reported in adults, studies on children and adolescents have often correlated direct/indirect smoke with allergic rhinitis, with prolonged exposure being associated with a higher risk of allergic rhinitis, particularly when exposed at an early age. Nonallergic inflammatory reactions and immunoglobulin E-mediated allergic sensitization are assumed to be the underlying mechanisms for the association between allergic rhinitis and smoking. Measures to reduce smoking are warranted to lower the incidence of allergic rhinitis in children and adolescents and to improve their health. (Allergy Asthma Respir Dis 2022;10:189-194)

Purpose: Allergen-specific immunotherapy (AIT) is the only known curative treatment for allergic diseases. Recently, novel immunotherapies have been developed to overcome the inconvenience and adverse reactions associated with conventional AIT. Validated animal models are essential for screening novel immunotherapies; however, effective models for AIT in allergic rhinitis (AR) are lacking. Herein, we aimed to develop an optimal protocol for AIT using a house dust mite (HDM)-induced AR mouse model.
Methods: BALB/c mice were intraperitoneally injected with the alum-absorbed HDM extract (5 μg) on days 0, 7, and 14. Sensitized mice were administered three subcutaneous injections of HDM extract (250 μg/100 μL; SCIT group) and phosphate-buffered saline (100 μL; negative and positive control groups) at 2-day intervals. Next, HDM extract (25 μg) was intranasally administered to SCIT and positive control groups for five consecutive days. Nasal symptoms, ear swelling, eosinophil count, antibody levels, and nasal mucosa histopathology were assessed in all groups. Cytokine production was analyzed in the splenocyte culture supernatant.
Results: Compared with the positive control group, the SCIT group exhibited reduced nasal symptoms, ear swelling, and eosinophil count in nasopharyngeal lavage. Compared with the positive control group, the SCIT group had reduced eosinophil, mast cell, and goblet cell counts in the nasal mucosa. Serum levels of HDM-specific IgG1 were higher in the SCIT group than in the positive control group. The stimulation index of splenocytes was reduced in the SCIT group when compared with that in the positive control group. Compared with the positive control group, the SCIT group exhibited decreased levels of interleukin (IL)-4 and IL-17, whereas those of IL-10 and interferon-gamma levels were increased.
Conclusion: AR mice treated with the AIT-HDM protocol showed attenuated nasal symptoms and improved histopathological findings and cytokine profiles compared with the untreated AR mice. Our findings suggest that the examined model may be useful for screening new AITs. (Allergy Asthma Respir Dis 2022;10:195-201)

Purpose: Meconium aspiration syndrome (MAS) occurs when aspiration of meconium itself or meconium-stained amniotic fluid enters into the airways. The relationship between MAS and how they affect the respiratory outcome after recovery from MAS remains unknown. The purpose of this study was to determine the type of lower respiratory tract illness (LRTI) in those surviving MAS survivors and to find out whether any clinical findings or treatment determine the type of LRTI.
Methods: We used the Catholic Medical Center's clinical data warehouse to review data from 4 university hospitals. We first included 1,331 newborns born between March 2016 and February 2021 with diagnostic codes including labor and delivery complicated by fetal stress (distress), intrauterine hypoxia, and neonatal aspiration syndromes. We finally included 239 patients who visited the out-patient clinic with diagnosis of pneumonia, acute bronchitis, acute bronchiolitis, and asthma, according to the Korean Standard Classification of Diseases.
Results: We observed a significantly higher number and fraction of eosinophils at birth in the bronchitis group. We also found significantly lower levels of white blood cells in the asthma group. After a regression analysis, we found that mechanical ventilation and steroid usage for treatment for of MAS was significantly related to bronchitis, and that antibiotics treatment acted as a protective factor for bronchiolitis.
Conclusion: Laboratory findings and treatment at birth in infants with MAS appear to have impact on determining LRTI in those who survived MAS. (Allergy Asthma Respir Dis 2022;10:202-206)

Purpose: Mycoplasma pneumoniae pneumonia (MP) is a major cause of community-acquired pneumonia (CAP) in children and is associated with extrapulmonary manifestations (EPM). The incidence and risk factors for EPM in children are unknown.
Methods: This was a retrospective study involving 65,243 pediatric patients with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Medical records were reviewed to collect information regarding the clinical characteristics, radiological results, and laboratory findings. Logistic regression with multivariate analysis was performed to evaluate the risk factors associated with EPM in MP.
Results: The incidence of EPM was 23.9%, including elevation of liver enzymes (18.1%), mucocutaneous manifestations (4.4%), proteinuria (4.1%), cardiovascular and neurological manifestations (0.4%), hematologic manifestations (0.2%), and arthritis (0.2%). Statistical analysis showed that mucocutaneous manifestations significantly increased with elevated alanine aminotransferase (adjusted odds ratio [aOR], 3.623; 95% confidence interval [CI], 1.933-6.790) and atopic sensitization (aOR, 2.973; 95% CI, 1.615-5.475) and decreased with respiratory virus coinfection (aOR, 0.273; 95% CI, 0.084-0.887). Elevated liver enzymes were significantly associated with elevated lactate dehydrogenase (aOR, 3.055; 95% CI, 2.257-4.137), presence of pleural effusion (aOR, 2.635; 95% CI, 1.767-3.930), and proteinuria with respiratory virus coinfection (aOR, 2.245; 95% CI, 1.113-4.527).
Conclusion: Approximately 24% of pediatric patients with MP had various EPM. As the risk factors associated with each EPM were different, it is necessary to evaluate the various clinical aspects and findings of MP to predict and prepare for the occurrence of EPM. (Allergy Asthma Respir Dis 2022;10:207-214)

Food allergy is a rare form of feeding intolerance in preterm infants, with symptoms similar to necrotizing enterocolitis. We report a case of clinically diagnosed cow's milk-induced eosinophilic enterocolitis in an infant with extremely low birth weight. The patient was born at 24 weeks and 1 day gestation, weighing 610 g, had repeated episodes of gastrointestinal symptoms after feeding, and was placed on nil per os. On day 67, the eosinophil count increased suddenly (7,852.8/mL), and the formula was changed to amino acid-based (Neocate). Gradually, the eosinophil count returned to normal. Ileostomy was performed and full enteral feeding was achieved with Neocate. Intraoperatively, the intestine was nonnecrotic and viable; the biopsy report showed massive mucosal eosinophilic infiltration. The patient was diagnosed with cow's milk-induced eosinophilic enterocolitis. (Allergy Asthma Respir Dis 2022;10:215-218)

Epidemiological evidence suggests that the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is lesser and morbidity and mortality rates are lower in children than in adults. Although respiratory viral infections are major triggers of asthma exacerbations in children, the association between asthma and SARS-CoV-2 infection remains unclear. We describe a previously healthy 13-year-old male adolescent who developed severe acute asthma exacerbation following coronavirus disease 2019 (COVID-19) infection. This case report describes new-onset asthma as severe exacerbation following COVID-19 infection and highlights the importance of ongoing surveillance of the wide spectrum of COVID-19 manifestations in children. (Allergy Asthma Respir Dis 2022;10:219-221)

Providing a protocol in the case of multiple food allergies is difficult although the demand of immunotherapy for patients with wheat anaphylaxis is increasing. This case series study aimed to report the wheat oral immunotherapy successfully achieving the maintenance dose along with immunological changes in children with multiple food anaphylaxis. In oral food immunotherapy, personalized therapeutic protocol, which sets the initial dose using the oral food provocation test and increase the dose considering the patients' needs and compliance, for each patient is essential. (Allergy Asthma Respir Dis 2022;10:222-228)

A 9-year-old child with cerebral palsy developed negative-pressure pulmonary edema (NPPE) followed by upper airway obstruction, which may be attributable to laryngospasm during recovery from general anesthesia. Therefore, the patient underwent repeat endotracheal intubation and was transferred to the intensive care unit. Mechanical ventilation and positive-pressure end-expiratory pressure led to resolution of pulmonary edema. The endotracheal tube was removed 1 day postoperatively, and the patient was discharged without sequelae. NPPE is rare in children and self-limited; however, delayed diagnosis and lack of appropriate treatment may be fatal. Notably, administration of general anesthesia to patients with cerebral palsy is associated with difficulty in airway intubation, decreased ventilatory function, aspiration of gastric contents, slow recovery from anesthesia, and anesthesia-induced adverse effects. Therefore, careful anesthesia management is warranted in children with cerebral palsy. In this case report, we describe the essential precautions during administration of general anesthesia to children with cerebral palsy and the pathophysiology, diagnosis, and treatment of NPPE, together with a literature review. (Allergy Asthma Respir Dis 2022;10:229-232)